HomeMy WebLinkAboutLA098372 PERMIT
Clt~~ Of Lakeville Permit Type: Plumbing
20195 Holyoke Ave Permit Number: LA098372
Lakeville, MN 55044 Date Issued: 05/09/2007
(952) 985-4440
www.ci.lakeville.mn.us
Site Address: 16460 Elm Creek La 5
Lot: Block: Addition:
PID:
Use:
DeSCrlptlon:
Sub Type: Water Meter 0 Plumbing
Work Type: Addition
Description: Water Meter for Fieldstone Creek 2nd
Meter Size Meter Tvpe Manufacturer Serial Number Remote Number Line Size
Comments:
Fee Summary: Descri tion Amount Revenue Code
Water Meter $1,550.00 7600-5161
MXU $130.00 7600-5163
Reducing Valve $315.00 7600-5165
Total: $1,995.00
COntraCtOr: -Applicant - OWner:
' GENZ RYAN PLMBG & HTG DR HORTON
2200 WEST HIGHWAY 13 ,
BURNSVILLE, MN 55337
(952) 767-1000
I HEREBY AGREE THAT THIS WORK WILL BE PERFORMED ACCORDING TO: (1) THE APPROVED PLANS &
SPECIFICATIONS; (2) THE APPLICABLE CITY ORDINANCES & CODES; AND (3) THE MN STATE BUILDING CODE. A
SEPARATE ELECTRICAL PERMIT IS REQUIRED
Applicant/Permitee: Signature Issued. By: Signature
PLUMBING PERMIT APPLICATION fice Use Only
• ~ ~ Permit Numbe~
• CITY OF LAKEVII,LE
r' BUII.DING INSPECTIONS DEPARTMENT
i ~ 20195 HOLYOKE AVENUE
J Received By
LAKEVILLE, MN 55044
•~~"rl 952-98511440
~~~•~?<ss:r~•~?~
www.ci.lakeville.mn.us Date Received
DATE YOUR E-MAIL ADDRESS
SITE ADDRESS L~ Cc ~ Vv~ ~
~ TENANT ~ 7 ~ ~i' ~ SIJII~ NO.
THE APPLICANT IS: ? RESIDENT OWNER ? CONTRACTOR
i NAME
RESIDENT OWNER ADDRESS
CITY STATE ZII'
DAYTIIv1E PHONE # WHERE YOU CAN BE REACHED
COMPANY NAME ~ ~Z ' ~ y~ .rte LICENSE #
ADDRESS Zoo ~ t-~(.~'>' t3
CONTRACTOR CTI'Y $?,~.Q ?.~~J ~ ~ STATE M ZIP ,SS3~
OFFICE PHONE # FAX #
CONTACT NAME PHONE
COMMERCIAL ONLY RESIDENTIAL ONLY
? COMM PLMBG SYSTEM ? LAWN SPRINKLER ? INSIDE PLBG
PERMIT TYPE ? COMM/IvI[TLTI-FAMILY ? WATER SOFTENER CONVERSION
LAWN SPRINKLER ? WATER HEATER ? ADDN/REPAIR
? FIRE SPRINKLER ? MISC
? RPZ Available on-line Residential Permits Available on-line
~f%NEW ? ADDITION ? ALTER /REMODEL
TYPE OF W ORK
? REPAIR ? REPLACE ? DEMOLITION
JOB DESCRIPTION ~~.1Tn~3 t ~ M E 1 ~ R (~ib[°~N~ ~ rJ~~`-fl e..p -94711~r.~
RESIDENTIAL FEES:
Repairs/Remodel or Water Heater $40.00 (39.50 + .50 surcharge) Water Softener $20.00 (19.50 + .50 surcharge)
COMMERCIAL FEES:
JOB COST: $
Ex m 1 12 000 Job Cost
a e. $ ,
p
1-1/2% of contract cost up to $10,000 and $10,000.00 x 1.5% _ $150.00
1% of cost above $10,000 plus surcharge. + $ 2,000.00 x 1% = 20.00
(Surcharge =Contract Cost x .0005) + $12,000 x .0005 = 6.00
TOTAL = TOTAL $176.00
Minimum of X40.00 (39.50 + .50 surcharge)
NO. OF METERS SIZE OF METER LOCATION OF METER
Z" m R f~c~~ WT ~ u0 v-+- ~
I hereby apply for an electrical permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance
with the ordinances and codes of the City of Lakeville and with the Minnesota Building Codes; that I understand this is not a permit but only an
application for a permit and work is not to start without a perrnit; that the work will be in accordance with the approved plan in the case of all work
which requires review and approval of plans.
NAME OF APPLICANT (Please Prurt) ~ ~ Date J ~ ~
SIGNATURE OF APPLIC
PLEr1SE 1?if)'Fl SF.P~12_~TE:PF;Ri::.'I4 )~,QLIi 2 ~ti1 BUILIjiNG,1LIECIiA1YICALyYEi
E!v"1'RICAL~'~ORI~ <
w-
•
PLUMBING PERMIT APPLICATION PAGE 2
OFFICE USE
SYSTEM TYPE: INSPECTIONS:
NEW ROUGH-IN
ADDITION / FINAL
REPAIIZ RPZ TEST REPORT
DEMOLISH COMBUSTION AIR.
REPLACE UNDERGROUND
ALTER/REMODEL
PERMIT FEE:
PERMIT FEE: $
SURCHARGE: $
METER: $ !
REDUCING VALVE: $ -~-r~
MXU $ 1
OTHER: $
TOTAL: $ < ~ ~J r
ISSUED BY: ~ DATE: ~ ~ ' /
COMMENTS:
Revised 01/01!2007